What is the most likely diagnosis? What tests and/or imaging tools could be used to confirm the diagnosis?

A 77-year-old man is brought to the emergency department by his daughter after
he developed weakness in his right upper extremity. She says that he has been sick
for the past two weeks with fever, chills, and night sweats and that he has lost nearly
4.5 kg (10 lb) during that time. He had attributed these symptoms to the fl u, but he
could not move his left arm when he woke this morning. He denies other symptoms.
On further questioning, his general health is good except for poorly controlled
hypertension, and he underwent an aortic valve replacement 2 months ago. Physical
examination is remarkable for upper left hemiplegia, the click of his prosthetic valve,
and the image below on funduscopic exam. Vital signs include a temperature of
38.9°C (102.0 °F), blood pressure of 114/55 mm Hg, and pulse of 115/min.

Right Answer

Diagnosis : the most likely
diagnosis is infective endocarditis (IE).

Tests :This diagnosis should be made by:
Three blood cultures separated by at least 1 hour from different... See More
venipuncture sites.
Stable patients and those who have received prior antibiotics
should not be treated empirically.
Unstable patients should receive empiric treatment once these
cultures are obtained.
Echocardiography should be done in all patients with moderate
suspicion of IE.
TTE should be attempted fi rst in most cases. TEE should be used
if TTE is nondiagnostic.
ECG baseline should be obtained.
Antibiotic treatment is organism specifi c and usually lasts 4–6 weeks
for native valves and at least 6 weeks for prosthetic valves.

2 minutes ago